*3.4.1 Prophylaxis of DFU*

Patients at risk of DFU should be managed by an interdisciplinary approach, including a diabetologist, a vascular surgeon, a podiatrist, a general surgeon, an orthopedic surgeon, a plastic surgeon and other specialists [82, 94, 102]. Stringent glycemic control is essential both in primary prevention of DFU and in ensuring wound healing. Management of high blood pressure and dyslipidemia is also important [86, 96, 97].

High-risk patients need education about the importance of wearing comfortable footwear, rigorous local hygiene, keeping feet dry and avoiding possible causes of local trauma (including barefoot walking) and frequent self-examinations [86, 96, 97]. Callus debridement, off-loading, and correct treatment of nail pathology are simple but

**267**

*Microvascular Complications of Diabetes Mellitus: Focus on Diabetic Retinopathy (DR)…*

extremely efficient measures for the prevention of foot ulcers [86, 96, 97]. LEADER trial suggests that treatment with liraglutide in patients with type 2 diabetes and at high risk of CV events did not increase the risk of DFU events and was associated with a significantly lower risk of DFU-related amputations compared with placebo [109].

Management of DFUs is aimed at correcting the pathogenic triad of neuropathy, PAD and infection. Off-loading with appropriate footwear and/or casts, debridement of callus and/or necrotic tissue, revascularization (by-pass grafting or intraluminal angioplasty) and infection control are the top priorities [86, 96, 97]. These may be aided by special dressings, skin substitutes, growth factors and other modalities [111–116]. Special care must be taken to recognize and promptly deal with emergencies requiring surgery and other urgent interventions [117].

Diabetic retinopathy and diabetic foot ulcer are both disabling complications, with a significant impact on the patient's quality of life and healthcare systems [118]. Microvascular impairment and local inflammation play a significant role in the both pathological mechanisms. Prevention and early detection, along with optimal control of blood sugar, hyperlipemia and arterial hypertension are the most

Peter Kempler has received honoraria from and/or is an advisory member of the following companies: Ely Lilly, Novo Nordisk, Novartis, Miro, Boehringer-Ingelheim, Woerwag-Pharma, Pfizer, Sanofi, Di-Care Zrt., 77 Elektronika Kft.,

*DOI: http://dx.doi.org/10.5772/intechopen.96548*

**4. Conclusions**

**Conflict of interest**

Teva, Astra-Zeneca.

*3.4.2 Therapeutic management of DFUs: main principles*

efficacious measures against these fearful complications.

*Microvascular Complications of Diabetes Mellitus: Focus on Diabetic Retinopathy (DR)… DOI: http://dx.doi.org/10.5772/intechopen.96548*

extremely efficient measures for the prevention of foot ulcers [86, 96, 97]. LEADER trial suggests that treatment with liraglutide in patients with type 2 diabetes and at high risk of CV events did not increase the risk of DFU events and was associated with a significantly lower risk of DFU-related amputations compared with placebo [109].
